Primary care workers vital for healthy longevity
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2023)

Access to affordable and quality primary health care is essential for healthy longevity. Quality primary care is associated with better health outcomes, increased health system efficiency, and improved health equity. However, the complex care needs of an ageing population, workforce shortages, and underfinancing, all of which were compounded by the COVID-19 pandemic, means that many primary health-care systems throughout the world are struggling. At a time of great pressure, governments must do their utmost to support their primary health-care systems and, crucially, their workforces, as staffing shortages affect patient safety and quality of care and exacerbate health inequities. WHO defines primary health care as “a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people's needs”. Quality in primary health care can be measured by several variables, such as safety, effectiveness, accessibility, and people-centredness, and relies on “a primary care workforce that is trained, supported and motivated to provide high-quality care”. However, many regions are facing workforce shortages. WHO sets a skilled health worker density (ie, physicians, nurses, and midwives) of 4·45 per 1000 population as a Sustainable Development Goal index threshold, but in the WHO Western Pacific region, nine out of 26 countries and areas in the region have staffing levels below this threshold. In the WHO Africa region, only four countries of 47 studied had levels above this threshold. Even traditionally more well-resourced health-care systems are experiencing workforce shortages. In the UK, the Future of General Practice report highlights an equivalent of 717 fewer fully qualified full-time general practitioners (GPs) in 2022 than in 2019. During this period, the number of GP appointments (excluding those for COVID-19 vaccination) rose by 8·9% and the number of people registered with GP surgeries rose by 3·2%; nevertheless, the shortage is predicted to continue rather than abate. A report by the Association of American Medical Colleges predicts that, by 2033, the USA will face a shortage of 21 400 – 55 200 primary care physicians. Countries with rapidly ageing populations, such as Italy and Japan, are also facing shortfalls in their primary health-care staff that are predicted to worsen over time. At the recent 28th WONCA Europe Conference, the frustration of many primary care physicians at the limited time they can spend with patients and the increasing demands upon their time was evident. Increasingly unsustainable working patterns lead to a vicious cycle of burnout, staff resignation, and increasing workload pressures for those remaining. In rural areas and in areas with greater socioeconomic deprivation, staff shortages are often even greater, which further deepens unequal health outcomes. Recruitment and retention of primary health-care staff is multifaceted. Across a range of settings, salary and other forms of compensation are important for staff retention. However, factors such as job satisfaction, adequate training, resourcing, and a suitable working environment are also key. Evidence for the best approaches to staff recruitment is mixed, but providing support for undergraduate and postgraduate placements and active recruitment of medical and nursing students from underserved areas could prove fruitful. However, strategies alone, no matter how well-intentioned, are meaningless without financial backing. Health-care systems must invest in their primary health-care staff. The recent launch of WHO's Health Impact Investment Platform, which will provide concessional loans and grants to low-income and middle-income countries to enable expansion of primary health-care services, with a focus on the most underserved communities, is very much welcome. As The Lancet's Global Health Commission on financing primary health care: putting people at the centre states: “to deliver high-quality PHC [primary health care], it is essential that doctors, nurses, and other cadres of staff are valued, with adequate remuneration and conditions of work to attract them into primary health care as a long-term career choice”. Primary health care is essential for a functioning health-care system, and a motivated and dedicated workforce is vital to ensure high-quality care for all. It is high time that governments worldwide make long-term commitments to investing in the training and support of the workforce that ensures health care at all stages of life.